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2021/10/23 JCOS Development, Inc.ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 7/7/2022 (925) 520-3321 10833 JCOS Development, Inc. 8201 Orangethorpe Ave. #D Buena Park, CA 90621 20260 35378 35076 A 1,000,000 X X VCGP028073 7/2/2022 7/2/2023 50,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000B 504610145894001 2/16/2022 2/16/2023 4,000,000C EZXS3084446 7/2/2022 7/2/2023 4,000,000 D X 9240317-2021 10/23/2021 10/23/2022 1,000,000 1,000,000 1,000,000 City of Menifee and its officers, employees, agents and authorized volunteers are included as Additional Insured in regards to General Liability as per written contract. Primary and Non-Contributory applies. Waiver of Subrogation applies to General Liability and Workers Compensation. City of Menifee 29844 Haun Road Menifee, CA 92586 JCOSDEV-01 MBENGCO Inszone Insurance Services, LLC 2721 Citrus Road, Suite A Rancho Cordova, CA 95742 Richard Choe rchoe@inszoneins.com Gemini Insurance Company Infinity Select Insurance Company Evanston Insurance Company State Compensation Ins Fund X X X X X X X DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 Policy Number: VCGP028073 CG 20 10 12 19 Insured Name: JCOS Development Inc Number: 34 Effective Date:07/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization when you have agreed in a written and executed contract, prior to an "occurrence", that such person or organization be added as an additional insured on your policy. All locations for which you have agreed in a written and executed contract prior to an "occurrence." Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 C.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. All other terms and conditions of this Policy remain unchanged. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VCGP028073 CG 20 37 12 19 Insured Name: JCOS Development Inc Number: 37 Effective Date: 07/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization when you have agreed in a written and executed contract, prior to an “occurrence”, that such person or organization be added as an additional insured on your policy. All locations and completed operations for which you have agreed in a written and executed contract prior to an “occurrence.” Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. All other terms and conditions of this Policy remain unchanged. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B VE 09 73 04 20 Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 Policy Number: VCGP028073 VE 09 73 04 20 Insured Name: JCOS Development Inc Number: 43 Effective Date: 07/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other Commercial General Liability insurance available to an additional insured under your policy, but only if: (1)The additional insured is a Named Insured under such other Commercial General Liability insurance; and (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other Commercial General Liability insurance available to the additional insured. Coverage granted to an additional insured remains subject to all terms, conditions, limitations, and exclusions set forth in the endorsement form that conferred the additional insured status. In the event of conflict between this endorsement and an endorsement conferring additional insured status, then the endorsement conferring additional insured status shall govern the scope of coverage available to the additional insured. All other terms and conditions of this Policy remain unchanged. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VCGP028073 CG 24 04 12 19 Insured Name: JCOS Development Inc Number: 38 Effective Date: 07/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Person(s) Or Organization(s): Any person or organization you have agreed in a written and executed contract, prior to an “occurrence”, that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. All other terms and conditions of this Policy remain unchanged. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B JCOS DEVELOPMENT INC 8201 ORANGETHORPE AVE STE D BUENA PARK, CA 90621 EFFECTIVE 10-23-2021 AT 12.01 A.M. AND EXPIRING 10-23-2022 AT 12.01 A.M. 10/14/2021 9240317-21 DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B CG 24 26 04 13 1 of 1 Policy: VCGP028073 CG 24 26 04 13 Insured Name: JCOS Development Inc Number: 16 Effective Date: 07/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF INSURED CONTRACT DEFINITION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part The definition of "insured contract" in the Definitions section is replaced by the following: "Insured contract" means: a.A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b.A sidetrack agreement; c.Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d.An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e.An elevator maintenance agreement; f.That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be considered an "insured contract" to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1)That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2)That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a)Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b)Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3)Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B VE 05 81 07 18 Included copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 2 Policy Number: VCGP028073 VE 05 81 07 18 Insured Name: JCOS Development Inc Number: 32 Effective Date: 07/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUBCONTRACTOR AND INDEPENDENT CONTRACTOR CONDITIONAL AMENDMENT OF DEDUCTIBLE This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Minimum Subcontractor and Independent Contractor Commercial General Liability Limits of Insurance Requirements Each Occurrence Limit $1,000,000 General Aggregate Limits (Other than Products-Completed Operations) $2,000,000 Products–Completed Operations Aggregate Limit $2,000,000 Personal and Advertising Injury Limit $1,000,000 SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the following condition: When work or operations are performed by others, including subcontractors and independent contractors, on any insured’s behalf, the insured shall obtain, prior to the start of work or operations, and have record of: 1.A written contract or agreement for the work or operations, that is signed by the person or organization performing operations on the insured’s behalf, that: a.Holds the insured harmless and indemnifies the insured for “bodily injury”, “property damage” and “personal and advertising injury” arising out of those operations or work, including work included in the “products completed operations hazard”; and b.Specifies the person or organization performing the operations has, and will maintain for the length of the statute of limitations in the jurisdiction in which the operations or work are performed, Commercial General Liability insurance coverage that: (1)Has minimum limits of insurance as shown in the Schedule above; (2)Is issued by a company with a minimum A.M. Best’s rating of A VII; (3)Does not contain restrictive or exclusionary language for their performance of the operations and work; (4)Covers the person or organization for their performance of the operations and work, including work included in the “products-completed operations hazard”; DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B VE 05 81 07 18 Included copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of 2 (5)Provides the insured coverage as an additional insured for the same; (6)Covers contractual liability for assumption of liability in an “insured contract,” including “bodily injury” claims asserted by any “employee” of the person or organization performing operations or work on behalf of the insured; and (7)Is primary and will not seek contribution from the policy. 2.Certificates of insurance confirming Commercial General Liability insurance coverage as specified above. If a subcontractor or independent contractor’s work directly or indirectly gives rise to a claim, and the insured fails to comply with the conditions set forth in this endorsement, coverage for such claim will be subject to the deductibles listed in the schedule below. Increased Deductible(s) Amount Coverage Amount per Occurrence or Offense Bodily Injury Liability $Not applicable OR Property Damage Liability $Not applicable OR Personal and Advertising Injury Liability $Not applicable OR Bodily Injury Liability; Property Damage Liability and / or Personal and Advertising Injury Liability Combined $25,000 All other terms and conditions of this Policy remain unchanged. DocuSign Envelope ID: 998FBAB6-A1BC-4783-B593-69502CFE908B